Examining Patient Preferences for Biologic Use in Psoriasis

Patients with psoriasis prefer biologics with a less frequent administration route and visit schedule, and lower risk of serious infections requiring hospitalization, according to study findings published in The Journal of Dermatology.

In the treatment of psoriasis, biologics have been associated with higher treatment satisfaction and greater quality of life improvement compared with other options. Choosing a biologic warrants consideration of the mechanism of action and efficacy for each drug, noted researchers, as well as the patient's background and certain ​​characteristics, such as dosing and frequency.

There are an estimated 430,000 to 560,000 patients with psoriasis in Japan, in which 11 biologics have been approved and are used in clinical practice for the treatment of moderate to severe disease.

“A better understanding of patient preferences could support physicians in their clinical practice to select optimal biologics that meet each individual patient's needs and ensure adherence to treatment,” said the study authors. “Limited studies from Japan have reported patient preferences for biologics in psoriasis treatment, and the main focus of these studies was on the improvement of skin symptoms.”

Aiming to describe patient preferences for the use of biologics, as well as assess social and clinical factors (subgroup analysis) that influence these preferences, they administered a web-based questionnaire survey using the discrete choice experiment (DCE) approach.

The following attributes were selected for the DCE: efficacy at 1 year (the rate at which at least 90% of psoriasis [skin] symptoms are cleared and efficacy is sustained for 1 year [52 weeks] after starting treatment), risk of serious infections requiring hospitalization (the annual rate of serious infectious events [eg, pneumonia] requiring hospitalization), incidence of injection site reactions (eg, pain, swelling, and/or redness), administration route and visits (a combination of dosing interval, administration route, and frequency of hospital visits), copayment, indications, and efficacy on skin symptoms and other manifestations.

Survey data were collected from October 4-8, 2021, which shortly followed the end of a declaration of a state of emergency by the Japanese government due to COVID-19 that was in effect from April until the end of September 2021. “Therefore, this study reflects the impact of the COVID-19 outbreak on patient preferences for biologics in psoriasis treatment,” the authors wrote.

The participants in the questionnaire survey were patients with psoriasis who had been registered in the patient panel owned by INTAGE Healthcare Inc (Tokyo, Japan). Eligible patients included persons aged 20 or older at the time of screening, those with a previous psoriasis diagnosis from a physician, and patients who were receiving treatment for psoriasis. The preferences of patients with psoriasis were evaluated using importance weight and relative importance (RI).

A total of 357 patients with psoriasis (mean age, 55.9 years; male, 75.35%) were included in the analysis as the overall patient population. Among the cohort, the most common localization of psoriatic lesions was the scalp (54.06%), followed by the lower extremities (thigh to ankle; 52.10%) and buttocks (39.50%). Nails, scalp, hands, feet, genitalia, and face were considered difficult-to-treat areas, and 292 patients (81.79%) had psoriasis symptoms in these areas.

Findings indicated that the most preferred attributes for biologics selection overall were administration route and visits (RI, 24.21%), followed by the risk of serious infections requiring hospitalization (RI, 23.10%), efficacy at 1 year (RI, 16.63%), incidence of injection site reactions (RI, 14.43%), and copayment (RI, 14.22%). The relative preference was lower for indications (RI, 3.87%) and efficacy on skin symptoms and other manifestations (RI, 3.54%).

Subgroup analyses further showed that preference tended to be higher for administration route and visits and risk of serious infections requiring hospitalization:

• Female patients with psoriasis had a higher preference for risk of serious infections requiring hospitalization (RI, 29.23%) and a lower preference for efficacy at 1 year (RI, 11.36%) than the overall patient population
• Lower preference for efficacy at 1 year was also shown for patients with psoriasis who had no lesions in difficult-to-treat areas (RI, 14.22%) and those with joint pain (RI, 10.21%)
• The 65 years-or-older group (n = 77) had lower RI for incidence of injection site reactions (RI, 10.65%)
• In all areas except the Shikoku/Chugoku region, patients had higher RI for administration route and visits and risk of serious infections requiring hospitalization
  

The researchers noted that findings contrast with the results obtained in previous studies, where the highest importance was placed on drug effectiveness. One limitation cited was that patients not registered in the patient panel owned by INTAGE Healthcare Inc and those without access to the survey website could not participate in the study.

“These results may reflect the personal and social impact of the COVID-19 outbreak at the time of the survey. The results of this study might help physicians properly select biologics that satisfy psoriasis patients' needs, leading to better treatment adherence," the study investigators concluded.

Reference

Tada Y, Itakura A, Hosono K, Kawamura T. Psoriasis patient preferences for the use of biologics during the coronavirus era. J Dermatol. Published online January 11, 2023. doi:10.1111/1346-8138.16703